Mixed receptive-expressive language disorder: what is it?

Summary of symptoms and causes of Mixed receptive-expressive language disorder.

Language and communication are of great importance, especially in childhood and early developmental stages, but also in adulthood, and throughout life.

There are multiple disorders that affect language... here we will see one of them: mixed receptive-expressive language disorder.. We will know what it consists of, what its diagnostic criteria are, how it manifests itself, what subtypes exist and, in short, what characteristics it presents.

Mixed receptive-expressive language disorder: what does it consist of?

The mixed receptive-expressive language disorder, also called "receptive dysphasia", is a language disorder characterized by the following characteristics both receptive and expressive language are below the norm according to the child's age, developmental level and intellectual capacity (compared to his/her reference group). intellectual capacity of the child (if we compare him/her with his/her reference group).

In other words, performance in these two areas is affected, and is below normal. This translates into difficulties in expressing ideas and in understanding what others are saying.

This is a more severe disorder than expressive disorder (where only expression is affected) or receptive disorder (where only comprehension is impaired).

As a result of the above, in the mixed receptive-expressive language disorder communication difficulties appear that may involve both verbal and nonverbal language (e.g., gestures). (e.g. gestures). In terms of prevalence, this disorder appears in approximately 3% of the child population.

Diagnostic criteria.

In order for a mixed receptive-expressive language disorder to be diagnosed, the diagnostic criteria for it must be met. The DSM-IV-TR (Diagnostic Manual of Mental Disorders) specifies the following criteria:

1. scores below expected 2.

Criterion A specifies that the scores obtained by means of assessments of both receptive and expressive language development from standardized, individually administered tests are below expected scores. and administered individually, fall substantially below those obtained from standardized assessments of nonverbal intellectual ability.

In criterion A, in addition, the following manifestations are specified, which appear in mixed receptive-expressive language disorder:

• Difficulties in understanding words, phrases or specific types of words (such as spatial terms).
• The same difficulties as in expressive language disorder (where only expressive language is affected).

Interference in performance

Criterion B of the mixed receptive-expressive language disorder states that deficits in both receptive and expressive language, create interference with academic or occupational performance, or social communication..

3. It is not a pervasive developmental disorder (PDD).

On the other hand, in order to be diagnosed with mixed receptive-expressive language disorder, the child must not meet the criteria for a PDD. In other words, the diagnosis of MDD would override the diagnosis of mixed receptive-expressive language disorder..

4. If there is another disorder, the deficits are excessive.

Finally, in the case of another previous diagnosis (for example: intellectual disability, environmental deprivation, sensory or motor speech deficit...), the deficiencies that appear in language exceed those usually associated with this type of disorder. That is to say, the previous diagnosis would not explain these difficulties.

Expressive and receptive language

In order to better understand what is involved in mixed receptive-expressive language disorder, we must differentiate between expressive and receptive language.

1. Expressive language

Expressive language has to do with speech at the motor level.. That is, it is the language used to communicate and to express ideas. If, for example, I ask a child what a certain object is, and he answers me, I am evaluating his expressive language.

2. Receptive language

Receptive language, on the other hand has to do with the comprehension of language. If, following the previous example, I ask a child to give me a certain object from a set of objects, in this case I am assessing receptive language.

Difficulties in expressive language

As we have seen, the main feature of mixed receptive-expressive language disorder is difficulties in both expressive and receptive language. In expressive language, how do these difficulties manifest themselves?

The child's vocabulary is significantly limited (i.e., he/she has little vocabulary). In addition, there are difficulties in producing fluid and rapid motor sequences. There are also difficulties in difficulties in remembering words or producing sentences of a length or complexity appropriate to the child's developmental age.. Finally, there is a general difficulty in expressing ideas.

Receptive language difficulties

Regarding receptive language in mixed receptive-expressive language disorder, there is basically a difficulty in understanding words, phrases or specific types of words. That is to say, roughly speaking, the child presents difficulties in understanding what is being said.

Other associated disorders

In addition to those mentioned above, there are other disorders or deficits associated with mixed receptive-expressive language disorder. These are the following:

• Discrimination problems
• Attentional problems
• Deficits in auditory memory
• Auditory sequential memory deficits

Subtypes of the disorder

There are two major subtypes of mixed receptive-expressive language disorder: developmental and acquired. Their course is different, as we will see below.

1. Developmental

The developmental subtype appears from birth. These are usually more severe cases, which are detected earlier (around 2 years of age). However, when they are milder cases, they are detected a little later (at 4 years of age).

2. Acquired

In the acquired subtype, as the name implies, the disorder is acquired by some injury or accident at the brain level.. In these cases, the course is variable, and depends on the location of the lesion, the severity of the lesion, the age of the child at the time of the lesion, etc.

Other classifications: DSM-5 and ICD

We have seen how mixed receptive-expressive language disorder is placed within the DSM-IV-TR, as a language disorder. However, the new version of the manual, the DSM-5, introduces changes and unifies comprehension and expression problems within a single disorder, which it calls "mixed receptive-expressive language disorder".within a single disorder, which it calls "Language Disorder". Thus, mixed receptive-expressive language disorder, in the DSM-5, would become language disorder.

On the other hand, in the ICD-10 (International Classification of Diseases, WHO), Mixed Receptive-Expressive Language Disorder does not exist as such; instead, it is usually diagnosed as either Expressive Disorder or Receptive Disorder (the more severe is diagnosed).

Bibliographical references:

• American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and statistical manual of mental disorders. Madrid: Panamericana.
• American Psychiatric Association (APA). (2002). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. Barcelona: Masson.
• Mulas, F., Etchepareborda, M., Díaz-Lucero, A. and Ruiz, R.(2006). Language and neurodevelopmental disorders. Review of clinical features. Journal of Neurology, 42(Suppl 2): S103-S10.
• WHO (2000). ICD-10. International classification of diseases, tenth edition. Madrid. Panamericana.
• Perelló, J., Guixá, J., Leal, M., Peña, J. and Vendrell, J.M. (1984): Language disorders. Barcelona, Científico-Médica.